- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,897.79 / $11,481.54
| Facility | | $1,479.11 | $4,897.79 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $1,862.09
| Professional | | $1,148.15 | $1,621.81 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,888.44 / $15,848.93 / $31,622.78
| Facility | | $5,888.44 | $15,848.93 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,621.81 / $3,235.94
| Professional | | $1,148.15 | $1,621.81 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,311.31 / $10,000.00
| Facility | | $398.11 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,235.94 / $8,709.64
| Professional | | $2,089.30 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,949.84 / $3,630.78
| Professional | | $1,288.25 | $1,949.84 | $3,630.78 |